753: Utilization of aspirin for prevention of preeclampsia in a high risk urban cohort

Abstract

Evaluate utilization of aspirin for preeclampsia prevention before and after implementation of a screening tool during nuchal translucency (NT) ultrasound. One year prospective cohort study of patients at high risk for preeclampsia after the implementation of a screening tool (post-screen) administered to all patients at check in for NT (11-13 week) ultrasound. Prospective cohort was compared to one year retrospective cohort (pre-screen) the year prior (2017). All patients who presented for NT ultrasound in both cohorts were evaluated for ≥1 high risk factor for preeclampsia (Table) by screening tool collected prospectively and chart review retrospectively. Provider recommendation for aspirin determined by documentation in prenatal record. Primary outcome was rate of provider recommendation for aspirin pre versus post screening tool, compared by chi-square analysis and adjusted for potential confounders with multiple regression analysis. Pre- (N=156) and post-screen (N=136) cohorts were similar except race and multifetal gestation (Table). Pre-screen, rate of provider recommendation for aspirin was 74%. Of those with prior preeclampsia, 96% were recommended aspirin, compared to 64% of patients with another risk factor (p< .001). Post-screen, provider recommendation of aspirin improved to 95% (p< 0.001), and aspirin recommendation for those with another risk factor but without prior preeclampsia also improved to 92% (Figure). Post-screening tool cohort had an increased adjusted odds of aspirin recommendation (OR 10.0 (3.7-26.8), p< .001). Implementation research is critical for evaluating and optimizing the real world use of national guidelines. Prior to implementation of a simple screening questionnaire, approximately 25% of high risk patients did not receive the recommendation of aspirin for preeclampsia prevention; those who lack a history preeclampsia were significantly less likely to be advised of aspirin prophylaxis. Use of a simple universal screening tool at time of NT ultrasound significantly improved utilization of aspirin for preeclampsia prevention.View Large Image Figure ViewerDownload Hi-res image Download (PPT)